Bayonne Pediatric Practice

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

25MA08140300 Issued in NJ

Legal business name

BAYONNE PEDIATRIC PRACTICE

Practice address

765 Kennedy Blvd
Bayonne, NJ 07002

Phone

(201) 823-4141

NPI assigned

Feb 5, 2016

Last updated

Dec 10, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Shalini Nagarajan Raghu, MDNPI 1942355680

Title

Owner

Phone

(201) 823-4141

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shalini Nagarajan Raghu, M.D.

  • Pediatrics Physician
  • Bayonne, NJ
  • NPI 1942355680
  Medicare reassignment NPD Authorized official
• Carmelita Pingol Malalis, M.D.

  • Pediatric Adolescent Medicine Physician
  • Bayonne, NJ
  • NPI 1598868523
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639094400000",
    "number": "1427416304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 TAMARACK RD",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088203630",
            "telephone_number": "201-823-4141",
            "fax_number": "201-823-1141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "765 KENNEDY BLVD",
            "city": "BAYONNE",
            "state": "NJ",
            "postal_code": "07002",
            "telephone_number": "201-823-4141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYONNE PEDIATRIC PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-05",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-10",
        "status": "A",
        "authorized_official_last_name": "RAGHU",
        "authorized_official_first_name": "SHALINI",
        "authorized_official_middle_name": "NAGARAJAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-823-4141",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA08140300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bayonne Imaging Associates, LLC.
• Bayonne Medical Center
• Bayonne Medical Plaza, LLC (Integrated Medical Center)
• Bayonne Ortho Fitting LLC (Bayonne Medical supply)
• Bayonne Pain Management Center, LLC
• Bayonne Pediatric Therapy Center LLC
• Bayonne Pharmacy Group LLC (Broadway Care Pharmacy)
• Bayonne Pharmacy Inc
• Bayonne Pharmacy Inc (Jerrys Drug & Surgical Supply)
• Bayonne Podiatry Group

• Pediatrics Physician in Bayonne, NJ
• Providers in Bayonne, NJ by specialty
• Pediatrics Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.